Duct penetrating method for pancreatojejunostomy with lost stent placement by push & pull technique

Abstract

Introduction: We developed a novel anastomotic technique (duct penetrating method: DPM) using a suture-assistant device for the reliable performance of duct-to-mucosa pancreaticoenterostomy. Although whether the placement of lost stent is superior to no stent or external stent remains controversial, we performed duct-to-mucosa pancreaticojejunostomy with lost stent placement using “push and pull technique”. Method: An atraumatic needle is purposely driven to penetrate both walls of the duct, while sparing the stump of the pancreas and incorporating an amount of pancreatic parenchyma with adequate depth and width around the duct. Suture placement is established by simple rotation of the needle driver along the curvature of the needle. A 5-0PDSII string is tied around a part of a pancreatic duct stent (4Fr).One side of the string is cut short, and the other side is cut long. The proximal and distal side of the stent should be cut 1.5cm apart from the knot. The lost stent is entirely pushed into the main pancreatic duct, then the proximal side of the stent is gradually induced into the jejunum side by holding the 5-0PDSII string until the string appears from the main pancreatic duct. Result: We performed DPM on 44 patients, and there was no cases of Grade C fistula. Over 100 patients were performed push and pull technique, the failure rate of this procedure is approximately 2%. Conclusion: A safe and reliable pancreaticojejunostomy is guaranteed by duct penetrating method. With push and pull technique, an appropriate insertion of an internal short stent would be guaranteed.